Circular 04/2017/TT-BYT schedule rates conditions costs covered health insurance participants

• Official number: 04/2017/TT-BYT
• Legislation Type: Circular
• Organization: The Ministry of Health
• Signer: Pham Le Tuan
• Issued Date: 14/04/2017

THE MINISTRY OF HEALTH --------	THE SOCIALIST REPUBLIC OF VIETNAM Independence - Freedom - Happiness ---------------
No.04/2017/TT-BYT	Hanoi, April 14, 2017

CIRCULAR

PROMULGATING THE SCHEDULE, RATES AND CONDITIONS OF PAYMENT OF COSTS OF COVERED MEDICAL SUPPLIES TO HEALTH INSURANCE PARTICIPANTS

Pursuant to the Law on Health Insurance;

Pursuant to the Government's Decree No. the Government's Decree No. 63/2012/ND-CP dated August 31, 2012 on defining the functions, tasks, powers and organizational structure of the Ministry of Health;

Pursuant to the Government's Decree No. 105/2014/ND-CP dated November 15, 2014 on specifying and guiding the implementation of a number of articles of the Law on Health Insurance;

Pursuant to the Government's Decree No. 70/2015/ND-CP dated September 1, 2015 on specifying and guiding the implementation of a number of articles of the Law on Health Insurance applied to the People’s Army, Police and Ciphering officers;

Upon the request of the Director of the Health Insurance Department,

The Minister of Health hereby issues the Circular promulgating the schedule, rates and conditions of payment of costs of covered medical supplies to health insurance participants.

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1. The Schedule of medical supplies of which health insurance coverage is provided for health insurance participants, which is prescribed in the Appendix 01 hereto attached, shall comprise medical consumables, man-made alternatives, replacements, implants and dedicated devices or accessories (hereinafter referred to as medical supplies).

2. The Schedule of medical supplies given in the Appendix 01 hereof shall serve as the basis for the health insurance fund’s payment of costs of medical supplies to health insurance participants in accordance with laws on heath insurance.

Article 2. Compilation and use of the Schedule of medical supplies of which health insurance coverage is provided for health insurance participants at healthcare service establishments

1. The Schedule of medical supplies used at health care service establishments must be compiled based on the Schedule of medical supplies given in the Appendix 01 hereto attached; demands for medical examination and treatment services; available personnel competence and capacity of medical equipment; list of medical technical services (hereinafter referred to as medical services) that has been approved by competent authorities and were actually consumed in the previous year according to the rules of safety, rationality, efficiency, conformity to medical service demands, relevance to payment capability of the health insurance fund; must prefer medical supplies that are domestically manufactured, have reasonable quality and prices.

2. After arriving at contractor selection results, healthcare service establishments shall send social security authorities the following documents for payment purposes:

a) The list of schedules of medical supplies of which costs have not been charged into prices of medical services, medical examination services and treatment bed days or lump-sum prices for specific visits of patients at healthcare service establishments, which is compiled by completing the form given in the Appendix No.02 hereto attached (both in a written document and electronic excel file format);

b) The decision on approval of the contractor selection plan and the decision on approval of results of selection of medical supplies contractors (both in a document and electronic excel file format).

3. If non-public healthcare service establishments choose to apply Article 52 of the Law on Procurement for their purchases of medical supplies, they must compile the list of schedules of medical supplies of which costs have not been charged into prices of medical services, medical examination services and treatment bed days or lump-sum prices for specific visits of patients at these establishments by completing the form given in the Appendix No.02 hereto attached and submit it to the relevant social security authority.

Article 3. General payment guide

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2. The health insurance fund shall make payments for medical supplies of which costs have not been charged into prices of medical services, medical examination services, treatment bed days or lump-sum prices for specific visits of patients as follows:

a) Payment bases shall be composed of:

- Actual quantity of medical supplies consumed by patients;

- Purchase prices of medical supplies prescribed by laws on procurement; if purchase prices of medical supplies are higher than the health insurance fund's payment or coverage amounts specified in the 5^th column of the Schedule of medical supplies of the Appendix 01 hereto attached, payment bases shall be payment or coverage amounts specified in the 5^th column of the Schedule of medical supplies of the Appendix 01 hereto attached;

- Conditions, rates and amounts of payment which are specified in the 5^th column of the Schedule of medical supplies in the Appendix 01 hereto attached;

- Scope and level of health insurance coverage which are specified in laws on health insurance;

b) The amount of payment of total cost of medical supplies in each use of medical service shall not exceed 45 months' base pay amount; this regulation shall not apply to medical supplies for which rates of payment are prescribed in the 5^th column of the Schedule of medical supplies in the Appendix 01 hereto attached;

Example 1 (Illustration of Point b Clause 2 Article 3): The amount of payment of total cost of medical supplies for a single use of medical services by an insured patient during the period when the statutory base pay equals VND 1,210,000 shall be calculated as follows:

- If this patient is the participant in the health insurance program who is entitled to a cover for 100% of medical examination and treatment costs, the amount of payment of total cost of medical supplies for a single use of medical services by the patient shall be determined as 45 x 100% x 1,210,000 = VND 54,450,000;

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- If this patient is the participant in the health insurance program who is entitled to a cover for 95% of medical examination and treatment costs and whose accumulated consecutive period of health insurance participation is more than 5 years:

+ If this patient has not yet made any co-payments for medical examination and treatment costs incurred within a year till the date of use of medical services, the amount of payment of total cost of medical supplies for a single use of medical services by this patient shall be determined as 45 x 95% x 1,210,000 = VND 51,727,000;

+ If this patient has already made co-payments for medical examination and treatment costs incurred within a year till the date of use of medical services of which the amount has reached 6 months' base pay amount, the amount of payment of total cost of medical supplies for a single use of medical services by this patient shall be determined as 45 months’ base pay amount equal to VND 54,450,000;

- If this patient is the participant in the health insurance program who is entitled to a cover for 80% of medical examination and treatment costs, but whose accumulated consecutive period of health insurance participation is not more than 5 years, the amount of payment of total cost of medical supplies for a single use of medical services by the patient shall be determined as 45 x 80% x 1,210,000 = VND 43,560,000;

- If this patient is the participant in the health insurance program who is entitled to a cover for 80% of medical examination and treatment costs and whose accumulated consecutive period of health insurance participation is more than 5 years:

+ If this patient has not yet made any co-payments for medical examination and treatment costs incurred within a year till the date of use of medical services, the amount of payment of total cost of medical supplies for a single use of medical services by this patient shall be determined as (45 x 80% x 1,210,000) + (45 x 20% - 6) x 1,210,000 = VND 47,190,000;

+ If this patient has already made co-payments for medical examination and treatment costs incurred within a year till the date of use of medical services of which the amount has reached 6 months' base pay amount, the amount of payment of total cost of medical supplies for a single use of medical services by this patient shall be determined as 45 months’ base pay amount equal to VND 54,450,000.

Example 2 (Illustration of Point a, b Clause 2 Article 3: If total cost of medical supplies is greater than 45 months’ base pay amount): During the period when the base pay amount per a month is VND 1,210,000, it is presumed that the patient is provided with 01 medical supply (item A) and 02 medical supplies (item B) for his/her single use of medical services. If the purchase price of item A is VND 50,000,000 and its amount of payment covered by the health insurance fund as specified in the 5^th column of the Schedule of medical supplies given in the Appendix 01 hereto attached is VND 42,000,000; the purchase price of item B is VND 10,000,000 and its amount of payment covered by the health insurance fund as specified in the 5^th column of the Schedule of medical supplies given in the Appendix 01 hereto attached is unidentified,

total cost of medical supplies (cost of item A is calculated based on the amount of payment specified in the 5^th column of the Schedule of medical supplies given in the Appendix 01 hereto attached and cost of item B is calculated based on its purchase price) for his/her single use of medical services shall be calculated as 42,000,000 x 1 + 10,000,000 x 2 = VND 62,000,000. As this cost is greater than 45 month’s base pay amount (VND 54,450,000), the health insurance fund shall agree with the amount of payment for total cost of medical supplies to insured patients entitled to different levels of coverage which is the same as that amount of payment specified in Example 1 (Illustration of Point b Clause 1 Article 3).

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Total cost of medical supplies (cost of item A is calculated based on the amount of payment specified in the 5^th column of the Schedule of medical supplies given in the Appendix 01 hereto attached and cost of item B and item C is calculated based on their purchase prices) for his/her single use of medical services shall be calculated as 35,000,000 x 1 + 3,000,000 x 2 + 2,000,000 x 3 = VND 47,000,000. As this cost is less than 45 months’ base pay amount (VND 54,450,000), the health insurance fund shall cover it for the patient as follows:

- If this patient is the participant in the health insurance program who is entitled to a cover for 100% of medical examination and treatment costs, the amount of payment of total cost of medical supplies for a single use of medical services by the patient shall be determined as 47,000,000 x 100% = VND 47,000,000;

- If this patient is the participant in the health insurance program who is entitled to a cover for 95% of medical examination and treatment costs, but whose accumulated consecutive period of health insurance participation is not more than 5 years, the amount of payment of total cost of medical supplies for a single use of medical services by the patient shall be determined as 47,000,000 x 95% = VND 44,650,000;

- If this patient is the participant in the health insurance program who is entitled to a cover for 95% of medical examination and treatment costs and whose accumulated consecutive period of health insurance participation is more than 5 years:

+ If this patient has not yet made any co-payments for medical examination and treatment costs incurred within a year till the date of use of medical services, the amount of payment of total cost of medical supplies for a single use of medical services by this patient shall be determined as 47,000,000 x 95% = VND 44,650,000;

+ If this patient has already made co-payments for medical examination and treatment costs incurred within a year till the date of use of medical services of which the amount has reached 6 months' base pay amount, the amount of payment of total cost of medical supplies for a single use of medical services by this patient shall be equal to VND 47,000,000;

- If this patient is the participant in the health insurance program who is entitled to a cover for 80% of medical examination and treatment costs, but whose accumulated consecutive period of health insurance participation is not more than 5 years, the amount of payment of total cost of medical supplies for a single use of medical services by the patient shall be determined as 47,000,000 x 80% = VND 37,600,000;

- If this patient is the participant in the health insurance program who is entitled to a cover for 80% of medical examination and treatment costs and whose accumulated consecutive period of health insurance participation is more than 5 years:

+ If this patient has not yet made any co-payments for medical examination and treatment costs incurred within a year till the date of use of medical services, the amount of payment of total cost of medical supplies for a single use of medical services by this patient shall be determined as (47,000,000 x 80%) + (47,000,000 x 20% - 6 x 1,210,000) = VND 39,740,000;

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c) If more drug-eluting stents are used in the coronary stenting technique, the amount of payment of total cost of medical supplies in a single use of medical services by an insured patient shall be subject to the payment guide specified in Point b Clause 2 of this Article, in addition to which the health insurance fund shall agree to provide a cover for another half (1/2) of cost of the second stent at the purchase price defined by the healthcare service establishment which does not exceed VND 18,000,000;

Example: Drug-eluting stent A is purchased by a healthcare service establishment at the price of VND 40,000,000; the amount of payment of cost of a drug-eluting stent that is specified in the 5^th column of the Schedule of medical supplies given in the Appendix 01 hereof is VND 36,000,000. An insured patient is hospitalized at a healthcare service establishment to be provided with the stenting service that requires placement of 03 items of drug-eluting stent A. Total cost of other medical supplies which have not yet been included in the price of medical service, medical examination service, treatment bed day or the lump-sum price of all costs incurred by each patient (hereinafter referred to as other medical supplies) is VND 15,000,000; the amount of payment for these medical supplies at the 5^th column of the Schedule of medical supplies given in the Appendix 01 hereto attached is unidentified.

- If this patient is the participant in the health insurance program who is entitled to a cover for 100% of medical examination and treatment costs, the amount of payment of total cost of medical supplies for a single use of medical services by the patient shall equal VND 54,450,000 the same as that calculated in the example 1 (illustration of Point b Clause 2 Article 3). Total cost of 01 item of drug-eluting stent A which is calculated based on the amount of payment specified in the 5^th column of the Schedule of medical supplies given in the Appendix 01 hereto attached and other medical supplies is calculated as 36,000,000 + 15,000,000 = 51,000,000; this cost is less than VND 54,450,000. The health insurance fund shall pay the patient (i) cost of the first stent and other medical supplies which equals VND 51,000,000; (ii) cost of the second stent which equals ½ x 36,000,000 = VND 18,000,000; (iii) shall not pay the patient cost of the third stent. In aggregate, the health insurance fund shall pay the patient total cost of medical supplies for his/her single use of medical services which equals:

51,000,000 + ½ x 36,000,000 = VND 69,000,000;

- If this patient is the participant in the health insurance program who is entitled to a cover for 80% of medical examination and treatment costs, but whose accumulated consecutive period of health insurance participation is not more than 5 years, the amount of payment of total cost of medical supplies for his/her single use of medical services shall equal 43,560,000 the same as that in the example 1 (illustration of Point b Clause 2 Article 3). Total cost of 01 item of drug-eluting stent A which is calculated based on the amount of payment specified in the 5^th column of the Schedule of medical supplies given in the Appendix 01 hereto attached and other medical supplies is calculated as 36,000,000 + 15,000,000 = 51,000,000; this cost is greater than VND 43,560,000. In aggregate, the health insurance fund shall pay the patient total cost which is calculated as:

43,560,000 + ½ x 36,000,000 = VND 61,560,000.

d) Participants in the health insurance program that are provided in Point b Clause 1 Article 4 of the Government’s Decree No. 105/2014/ND-CP dated November 15, 2014 and Article 2 of the Government’s Decree No. 70/2015/ND-CP shall not be required to comply with Point b Clause 2 Article 3 of this Circular and the limit on rate of payment for medical supplies that is prescribed in the 5^th column of the Schedule of medical supplies given in the Appendix 01 hereto attached.

3. If medical items which are classified into a medical specialty are used in medical services classified into another medical specialty, the health insurance fund shall agree to make payment for them under the provisions of this Circular.

Example: Costs of guide wires of all kinds and sizes classified into the interventional cardiology and radiology (Group 7.1) which are used in medical services of either the interventional cardiology or the gastroenterology (Group 7.4) shall be covered by the health insurance fund.

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5. The health insurance fund shall not make its payments if:

a) Costs of medical supplies have been covered by the state budget or other funds;

b) Medical supplies intended for medical services have not yet approved for use by competent authorities or fall outside of the scope of entitlements in accordance with laws on health insurance.

6. Where non-public healthcare service establishments choose to buy medical supplies in accordance with Article 52 of the Law on Procurement, the health insurance fund shall make its payments for these medical supplies at their purchase prices which do not exceed the winning prices of medical supplies of same categories (same commercial names, types, technical criteria, quality standards, manufacturers and countries of origin) and according to the contract execution period prescribed in the decision on approval of contractor selection results of healthcare service establishments in the following order of priority:

a) Public healthcare service establishments at the provincial level that have the largest proposed number of beds within their provinces;

b) Other healthcare service establishments at the provincial level or those at the central level that are located within these provinces, if medical supplies are not mentioned in the contractor award results at healthcare service establishments at the provincial level that have the largest proposed number of beds;

c) Healthcare service establishments at the provincial level or those at the central level that are located within adjacent provinces, if medical supplies are not mentioned in the contractor award results at public healthcare service establishments at the provincial level or those at the central level located within these provinces;

d) Other healthcare service establishments at the central level, if medical supplies are not mentioned in the contractor award results at public healthcare service establishments at the provincial level or those at the central level located within adjacent provinces.

Article 4. Guide to payment for certain types of medical supplies

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2. The health insurance fund shall make its payments for medical supplies for which amounts of payment are specified in the 5^th column of the Appendix 01 hereto attached according to the general payment guide referred to in Article 3 hereof (regulations on amounts of payment of total cost of medical supplies are not applied) and rates of payment specified in the 5^th column of the Schedule of medical supplies given in the Appendix 01 hereto attached.

Example: The winning price for supply of the set of resin microspheres filled with Y-90 radioactive isotope to a healthcare service establishment is VND 380,000,000.

Resin microspheres filled with Y-90 radioactive isotope are specified in the Schedule of medical supplies given in the Appendix 01 hereto attached and are relative to the stipulated rate of payment which equals 40%.

If the patient is the participant in the health insurance program who is entitled to 100% of cover of costs of medical examination, treatment and liver cancer treatment services that require use of sets of resin microspheres filled with Y-90, including microspheres, lead pots, vials, tubes containing standard doses, cannula, needles and syringes particularly intended for administering radioactive granules, the health insurance fund shall pay an amount calculated as 380,000,000 x 40% x 100% = VND 152,000,000.

3. In respect of medical supplies of which determination of the quantity is difficult:

a) Based on medical conditions and frequency of rendering of medical services, healthcare service establishments shall set the limit on use of these supplies and notify this in writing to social security authorities.

b) The health insurance fund shall make its payment for costs of medical supplies for each use of medical service which is determined as the purchase price multiplied by (x) the designated limit;

c) If, according to the medical indication, the patient is prescribed only a part of medical supplies purchased by a healthcare service establishment and the rest of medical supplies is not used for certain reasons (e.g. no user, insufficient quantity or expiration), the health insurance fund shall pay all costs incurred from use of these medical supplies at their purchase price.

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a) If all components of the “set” are entirely used, full payment for the whole set shall be made;

b) If one or several components of the “set” are used,

- the full payment for the whole set shall be made in the event that the rest of components of the "set” is unusable. Healthcare service establishments shall take an inventory of unusable components and notify this in writing to health insurance authorities;

- The payment for each used component at its predetermined price shall be made in the event that separate prices of specific components of the “set” are available;

- If there is none of separate prices of specific components used, based on the purchase price of the “set” and particular characteristics of specific medical supplies, healthcare service establishments shall take an inventory of components already used, not yet used and notify this in writing to health insurance authorities for payment purposes.

Article 5. Provisions on payment for reused medical supplies.

1. The health insurance fund’s payment for reusable medical supplies according to the Ministry of Health’s instructions on the reuse process and times shall conform to instructions provided by the Ministry of Health.

2. In respect of reusable medical supplies of which instructions for the process and times of reuse have not yet been provided by the Ministry of Health or manufacturers, Directors of healthcare service establishments shall, depending on medical requirements, reality and upon the request of the Scientific Advisory Board or Medicine and Therapy Board (if mandated by Directors of healthcare service establishments), set up and approve the reuse process and times, and notify social security authorities in writing for payment purposes. Sum of payment for medical supplies for a single use shall be identical and determined according to the following formula:

Payment sum =

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+ C_hskk

n_tb

Where:

a) G_vtyt means the price of a medical item that is calculated according to the price at which it is purchased in accordance with laws on procurement;

b) n_tb means within-year average times of use which are calculated according to the formula n_tb = n_{sdtt(previous year)} x k. If it is the first year that a healthcare service establishment reuses medical supplies, n_tb is calculated after Director of this establishment consults it from other establishment; additionally, based on capacity and frequency of performing medical services in which reused medical supplies are used within a specified year, and opinions of the Scientific Advisory Board or the Medicine and Therapy Board (if mandated by the Director of the healthcare service establishment) in that establishment, the Director shall make his/her decision and notify this in writing to social security authorities;

c) n_{sdtt(previous year)} means average times of actual use within the preceding year which are calculated as total number of uses of medical supplies by a patient within the preceding year divided by total quantity of medical supplies already used within that preceding year;

d) k means the risk adjustment coefficient value of 0.8;

dd) C_hskk means cost of sterilization, drying and disinfection allocated for a single use of medical supplies which is calculated according to the following formula:

C_hskk =

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n_tb

Where: C_hskktt means total actual cost of sterilization, drying or disinfection (inclusive of cost of electricity, water, disinfectant, gloves, packaging, damage to sterilization and drying equipment and wage) incurred in each time of sterilization, drying or disinfection of a unit of medical supplies.

3. In the beginning of a specified year or prior to commencement of reuse of medical supplies, based on medical requirements, reality and technical conditions of a healthcare service establishment, the Director of that establishment shall notify social security authorities of:

a) Maximum times of use (n_td) of each item of medical supplies. Each item of medical supplies shall not be used in excess of the maximum times of use;

b) Sum of payment for medical supplies in each use, subject to provisions laid down in Clause 1 and 2 Article 5 hereof.

4. At the end of a specified year, healthcare service establishment and social security authority shall define average times of actual use of medical supplies within that year (n_{sdtt(within year)}) as the basis for calculation of actual times of use (n_tb) for the next year and adjust payment of total cost of insured medical examination and treatment services incurred at this establishment within that year under the following circumstances:

a) If average times of actual use within a specified year (n_{sdtt(within year)}) are greater than times of restricted use (n_gh) qualifying for health insurance coverage (n_gh= 1.3 x n_tb), an adjustment in which total cost of insured medical examination and treatment service is reduced shall be calculated based on average times of actual use that exceed times of restricted use as follows:

Decreasing adjustment = (n_{sdtt(within year)} - n_gh) x number of medical supplies used within year x

G_vtyt

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b) If average times of actual use within a specified year (n_{sdtt(within year)}) are less than average times of use (n_tb), an adjustment in which total cost of insured medical examination and treatment service is increased shall be calculated based on the difference portion between average times of use and average times of actual use within year as follows:

Increasing adjustment = (n_tb – n_{sdtt(within year)}) x number of medical supplies used within year x

G_vtyt

n_tb

Example: A healthcare service establishment conducts reuse of medical item A.

In 2015, there are 10 times of use of item A; the quantity of item A used is 02 units; price of each unit is VND 10,000,000; actual cost of each time of sterilization, drying and disinfection for a unit of item A is VND 200,000.

In the beginning of 2016, healthcare service establishment determines and notifies social security authority in writing of:

- Maximum times of use of item A is 07. This means that in 2016 each unit of item A is not used in more than 07 times;

- Sum of payment for medical supplies for a single use is determined as follows:

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n_{sdtt(year 2015)} = 10/2 = 5 times

Average times of use of 2016:

n_tb = n_{sdtt(year 2015)} x k = 5 x 0.8= 4.0

Cost of sterilization, drying and disinfection allocated for a single use of item A:

C_hskk =

(4-1) x 200,000

= VND 150,000

4

Sum of payment for item A for a single use of 2016 is determined as follows:

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G_vtyt

+ C_hskk

10,000,000

+ 150,000 = VND 2,650,000

n_tb

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At the end of 2016, healthcare service establishment and social security authority define average times of actual use of item A of 2016 ((n_{sdtt(year 2016)}):

n_{sdtt(year 2016)} =

Total times of a patient’s use of item A in 2016

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Times of restricted use qualifying for health insurance coverage:

n_gh = 1.3 x _­n_tb = 1.3 x 4 = 5.2

If n_{sdtt(year 2016)}= 4.5, compare n_tb= 4.0 ≤ n_{sdtt(year 2016)} ≤ n_gh = 5.2. In this case, adjustment to total cost of insured medical examination and treatment services within year at the healthcare service establishment is not required. Sum of payment for item A for a single use of 2016 is VND 2,650,000.

If n_{sdtt(year 2016)}= 6.5 > n_gh=5.2, decreasing adjustment to total cost of insured medical examination and treatment services within year at the healthcare service establishment is made as follows:

Decreasing adjustment

= (n_{sdtt(year 2016)} - n_gh) x Total consumption of medical supplies of 2016 x

G_vtyt

n_tb

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If n_sdtt = 3 < 4.0, increasing adjustment to total cost of insured medical examination and treatment services within year at the healthcare service establishment is made as follows:

Increasing adjustment

= (n_tb – n_{sdtt(year 2016)}) x Total consumption of medical supplies of 2016 x

G_vtyt

n_tb

= (4.0 -3) x Total consumption of medical supplies of 2016 x (10,000,000/4)

Article 6. Implementation

1. The Ministry of Health shall assume the following responsibilities:

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b) Undertake and cooperate with related authorities in resolution of difficulties that may arise during implementation of this Circular; update and revise the Schedule of medical supplies given in Appendix 01 hereto attached.

2. The Social Security of Vietnam shall assume the following responsibilities:

a) Conduct implementation of and make payment for medical supplies in compliance with this Circular and other relevant legislative documents;

b) Cooperate with the Ministry of Health and relevant entities in handling any difficulty that may arise in the course of implementation.

3. The Departments of Health of centrally-affiliated cities and provinces shall assume the following responsibilities:

a) Implement, check and inspect compliance with this Circular throughout their jurisdictions;

b) Undertake and cooperate with relevant entities in handling any difficulty that may arise in the course of implementation.

4. Health administrations of Ministries or sectoral departments shall be responsible for implementing and auditing compliance with this Circular within their jurisdiction.

5. Healthcare service establishments shall assume responsibilities:

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b) Manage and use medical supplies in accordance with regulations, ensure safety, relevance, cost efficiency and conformity with quality standards; make payments according to the rules of timeliness, correct category, correct quantity, correct price and correct cost;

c) Build the Schedule of medical supplies to be purchased or used at each establishment in accordance with Clause 1 Article 2 hereof;

d) Send social security authorities documents specified in Clause 2 and 3 Article 2 hereof as the basis for payment of costs of medical supplies;

dd) Issue the process for sterilization, drying and disinfection of reused medical supplies at healthcare service establishments; bear responsibility and ensure quality of reused medical supplies;

e) Provide invoices or documents evidencing purchases of medical supplies in respect of those of which costs have not yet been included in prices of medical services, medical bed days or lump-sum prices for specific visits of patients in each session of inspection and audit of costs of insured medical examination and treatment services;

g) Send a written proposal for revision or supplementation of the Schedule of medical supplies specified in Appendix 01 hereof where appropriate to the reality and in conformity with medical requirements of patients to the Ministry of Health (Department of Health Insurance) or the Departments of Health of centrally-affiliated cities and provinces that proceed with preparing a consolidated report for submission to the Ministry of Health (Department of Health Insurance), or to other competent authorities for submission of a consolidated report to the Ministry of Health.

Article 7. Transitional provisions

1. If health insurance participants are hospitalized prior to the date of entry into force of this Circular and discharged from hospital within or after the date of entry into force of this Circular, provisions laid down herein shall prevail.

2. In respect of medical supplies present in the Schedule annexed to the Circular No. 27/2013/TT-BYT dated September 18, 2013 of the Minister of Health that introduces the Schedule of medical supplies of which costs are covered by the health insurance fund (hereinafter referred to as Circular No. 27/2013/TT-BYT) and documents guiding the Circular No. 27/2013/TT-BYT, but not listed in the Schedule of medical supplies given in Appendix 01 hereof, the health insurance fund shall continue to make its payments until the number of medical supplies of which contracts for provision are awarded according to the results of selection of contractors supplying medical supplies, and contracts with suppliers for supply have been signed prior to this Circular’s entry into force, is used up.

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Article 8. Reference clause

In case reference documents used in this Circular are replaced, amended or supplemented, the newest versions of these documents created after being so replaced or amended shall become effective.

Article 9. Entry into force

1. This Circular shall enter into force from June 1, 2017.

2. The Circular No. 27/2013/TT-BYT and documents guiding the Circular No. 27/2013/TT-BYT shall become invalid from the date of entry into force of this Circular.

In the course of implementation of this Circular, if there is any difficulty or proposal for revision or supplementation of this Circular, entities, organizations and individuals shall consult with the Ministry of Health (Department of Health Insurance) about any possible solution./.

PP. THE MINISTER
THE DEPUTY MINISTER




Pham Le Tuan

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APPENDIX 01

SCHEDULE OF MEDICAL SUPPLIES QUALIFYING FOR HEALTH INSURANCE COVERAGE
(Annexed to the Circular No. 04/2017/TT-BYT of the Minister of Health dated April 14, 2017)

No.

Group code

Group and category of medical supplies

Unit of measurement

Note

(1)

(2)

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(4)

(5)

N01.00.000

Group 1. Cotton, antiseptic liquids and wound cleansers

Do not qualify for separate payments

N01.01.000

...

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...

1

N01.01.010

Cotton wools or cotton impregnated with solutions

Gram, kg, bag, roll

2

N01.01.020

...

...

...

Wad, piece

N01.02.000

1.2 Antiseptic liquids and wound cleansers

3

N01.02.010

...

...

...

Ml, litre

4

N01.02.020

Antiseptic wound cleansers

Ml, litre, bottle

5

N01.02.030

...

...

...

Ml, litre

6

N01.02.040

Antibacterial sterilizer solutions used in medical labs, operating rooms and patient rooms

Ml, litre

7

N01.02.050

...

...

...

Ml, litre

N02.00.000

Group 2. Bandages, gauzes and other dressings used for stopping bleeding and healing wounds

N02.01.000

...

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...

Do not qualify for separate payments

8

N02.01.010

Powder bandages, fabric bandage padding, tubular stockinette bandages of all sizes

Roll

9

N02.01.020

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...

Roll, pad

10

N02.01.030

Orthopaedic and trauma cast of all sizes

Roll

11

N02.01.040

...

...

...

Roll, pad

12

N02.01.050

Dressings of all sizes used for surgeries, wounds, burns and ulcers

Roll, pad

13

N02.01.060

...

...

...

Roll, piece

14

N02.01.070

Sterile bandages of all sizes

Roll, pad

N02.02.000

...

...

...

Do not qualify for separate payments

15

N02.02.010

Eyelid plasters of all sizes

Pad

16

N02.02.020

...

...

...

Roll, pad

N02.03.000

2.3 Gauzes, bandages and dressings used for injury or wound treatment

17

N02.03.010

...

...

...

Pad

18

N02.03.020

Gauzes of all sizes

Roll, pack, pad

19

N02.03.030

...

...

...

Pad

20

N02.03.040

Hydrocolloid dressings of all sizes

Pad

21

N02.03.050

...

...

...

Pad

22

N02.03.060

Umbilical gauzes of all sizes

Pad

23

N02.03.070

...

...

...

Pad

24

N02.03.080

Gauze sponges or foam dressings of all sizes

Pad

25

N02.03.090

...

...

...

Pad

26

N02.03.100

Antibacterial plasters of all sizes

Pad

N02.04.000

...

...

...

27

N02.04.010

Topical sprays used for decubitus ulcer prevention and treatment

Bottle, jar

28

N02.04.020

...

...

...

Pad

29

N02.04.030

(Biological) topical skin or tissue adhesives used for surgeries

Jar, pad, kit

30

N02.04.040

...

...

...

Pad, bar

31

N02.04.050

Hemostatic materials (wax, bone, surgicel, merocel, spongostan, gelitacel, floseal hemostatic and liotit)

Pad, bar, kit

32

N02.04.060

...

...

...

Set

N03.00.000

Group 3. Syringes, needles, catheters, gloves and other medical supplies used for patient care

N03.01.000

...

...

...

33

N03.01.010

Feeding syringes of all sizes

Item

34

N03.01.020

...

...

...

Item

35

N03.01.030

High pressure syringes of all sizes

Item

36

N03.01.040

...

...

...

Item

37

N03.01.050

Reusable syringes of all sizes

Item

38

N03.01.060

...

...

...

Item

39

N03.01.070

Disposable syringes with attached needles of all sizes

Item

40

N03.01.080

...

...

...

Item

N03.02.000

3.2 Needles

41

N03.02.010

...

...

...

Item

42

N03.02.020

Winged infusion needles of all sizes

Item

43

N03.02.030

...

...

...

Item

44

N03.02.040

Needles of all sized designed for implantable subcutaneous ports

Item

45

N03.02.050

...

...

...

Item

46

N03.02.060

Blood collection and medicine extraction needles of all sizes

Item

47

N03.02.070

...

...

...

Item

48

N03.02.080

Disposable needles of all sizes

Item

49

N03.02.090

...

...

...

Unit, piece

N03.03.000

3.3 Puncture, biopsy and other needles

50

N03.03.010

...

...

...

Item

51

N03.03.020

Cell aspiration needles of all sizes

Item

52

N03.03.030

...

...

...

Item

53

N03.03.040

Needles of all sizes for percutaneous abscess drainage

Item

54

N03.03.050

...

...

...

Item

55

N03.03.060

Needles of all sizes used in ultrasound transducers

Item

56

N03.03.070

...

...

...

Item

57

N03.03.080

Hemodialysis needles of all sizes

Item

58

N03.03.090

...

...

...

Item

59

N03.03.100

Reusable biopsy needles of all sizes

Item

60

N03.03.110

...

...

...

Item

61

N03.03.120

Localization needles of all sizes

Item

62

N03.03.130

...

...

...

Item

63

N03.03.140

Laser needles, thermal ablation tips, wires and intravenous catheters of all sizes

Item

64

N03.03.150

...

...

...

Item

65

N03.03.160

Bone puncture and biopsy needles of all sizes

Item

N03.04.000

...

...

...

Do not qualify for separate payments

66

N03.04.010

Acupuncture needles of all sizes

Kit, item

N03.05.000

...

...

...

67

N03.05.010

Guidewires and infusion catheters of all sizes (inclusive of attached connectors, manifolds, stopcock and connecting tubes)

Set

68

N03.05.020

...

...

...

Set

69

N03.05.030

Intravenous cannulas of all sizes used for blood or blood product transfusion

Set

70

N03.05.040

...

...

...

Item

71

N03.05.050

Intravenous cannulas of all sizes used for infusion pumps

Set

72

N03.05.060

...

...

...

Item

N03.06.000

3.6 Gloves

Do not qualify for separate payments

73

N03.06.010

...

...

...

pair

74

N03.06.020

Patient care and treatment gloves of all sizes

Pair

75

N03.06.030

...

...

...

Pair

76

N03.06.040

Sterile gloves of all sizes used for functional assessment and medical test

Pair

77

N03.06.050

...

...

...

Pair

N03.07.000

3.7 Sachets, bags, bottles, jars and other packing materials

Do not qualify for separate payments

78

N03.07.010

...

...

...

Piece, set

79

N03.07.020

Collector bags for measurement of postpartum blood loss of all sizes

Item

80

N03.07.030

...

...

...

Item

81

N03.07.040

Food, fluid or nutrient bags or pots of all sizes

Item

82

N03.07.050

...

...

...

Item

83

N03.07.060

Bags, sachets, cassettes of all sizes for collecting or measuring waste bodily products and fluids

Item

84

N03.07.070

...

...

...

Item

85

N03.07.080

Artificial anus bags

Item

N04.00.000

...

...

...

N04.01.000

4.1 Tubes or cannulas

86

N04.01.010

...

...

...

Item

87

N04.01.020

Cannulas of all sizes for tracheal intubation and dilation

Item

88

N04.01.030

...

...

...

Set

89

N04.01.040

Reusable endotracheal tubes of all sizes

Set

90

N04.01.050

...

...

...

Piece, set

91

N04.01.070

Middle ear ventilating tubes of all sizes

Item

92

N04.01.080

...

...

...

Item

93

N04.01.090

Sondes of all sizes

Item

N04.02.000

...

...

...

94

N04.02.010

Disposable stomach wash kits of all sizes

Set

95

N04.02.020

...

...

...

Item

96

N04.02.030

Drains of all sizes for bodily fluid effusion

Item

97

N04.02.040

...

...

...

Item

98

N04.02.050

Vacuum aspirators of all sizes

Item

99

N04.02.060

...

...

...

Piece, set

100

N04.02.070

Wash and suction tubes or lines of all sizes designed for surgical equipment

Set

N04.03.000

...

...

...

101

N04.03.010

Guide wire sets for administration of fluids to joints of all sizes

Set

102

N04.03.020

...

...

...

Set

103

N04.03.030

Disposable oxygen supply lines of all sizes

Set

104

N04.03.040

...

...

...

Item

105

N04.03.050

2-line hubs with biosafety connectors of all sizes

Piece, set

106

N04.03.060

...

...

...

Item

107

N04.03.070

Lines for heart-lung machines of all sizes

Set

108

N04.03.080

...

...

...

Set

109

N04.03.090

Connecting tubes, lines and adapters of all sizes designed for medical devices

Item

110

N04.03.100

...

...

...

Piece, set

111

N04.03.110

Line kits of all sizes for peritoneal dialysis

Set

112

N04.03.120

...

...

...

Set

N04.04.000

4.4 Catheters

113

N04.04.010

...

...

...

Item

114

N04.04.020

Guiding catheters of all sizes

Item

115

N04.04.030

...

...

...

Item

116

N04.04.040

Minicaps for transfer sets of catheters particularly designed for peritoneal filtration of all sizes

Item

N05.00.000

...

...

...

N05.01.000

5.1 Surgical sutures

Do not qualify for separate payments

117

N05.01.010

...

...

...

Item

N05.02.000

5.2 Surgical threads

Do not qualify for separate payments

118

N05.02.010

...

...

...

Strand, roll, skein

119

N05.02.020

Special surgical sutures of all sizes

Strand, roll, skein

120

N05.02.030

...

...

...

Strand, roll, skein

121

N05.02.040

Suture threads of all sizes

Strand, skein

122

N05.02.050

...

...

...

Strand, roll, skein

123

N05.02.060

Fast absorbable threads of all sizes

Strand, roll, skein

124

N05.02.070

...

...

...

Strand, roll, skein

125

N05.02.080

Alternate materials of surgical threads of all sizes

Pad

126

N05.02.090

...

...

...

Strand, roll, skein

N05.03.000

5.3 Surgical scalpels

127

N05.03.010

...

...

...

Item

128

N05.03.020

Surgical scalpels and blades of all sizes

Item

129

N05.03.030

...

...

...

Item

130

N05.03.040

Ablation electrodes (monopolar, bipolar, integrated monopolar and bipolar), electric scalpels, laser scalpels, ultrasonic scalpels, plasma scalpels, radio scalpels, ultrasonic scalpels for liver resection, vessel sealing scalpels, tissue sealing scalpels of all sizes (including scalpel handles and fibers)

Item

131

N05.03.050

...

...

...

Strand, string

132

N05.03.060

Graft blades, cutting blades, cartilage incision scalpel and ablation blades of all sizes (including scalpel handles)

Piece, set

133

N05.03.070

...

...

...

Item

134

N05.03.080

Disposable scalpel blades of all sizes

Item

135

N05.03.090

...

...

...

Item

N06.00.000

Group 6. Prosthetics and implants

N06.01.000

...

...

...

136

N06.01.010

Artificial blood vessels of all sizes

Unit, segment

137

N06.01.020

...

...

...

Set

138

N06.01.030

Artificial heart valves, aortic valves of all sizes

Item

139

N06.01.040

...

...

...

Item

140

N06.01.050

Artificial heart valves combined with biostents of all sizes

Item

- In respect of aortic valve replacement surgeries, make payments in case of aortic valvular stenosis or regurgitation due to aortic valve calcification.

- In respect of pulmonary valve replacement surgeries, make payments in case of pulmonary valvular stenosis or regurgitation due to aortic valve calcification.

141

...

...

...

Mechanical or biological aortic valves of all sizes

Item

Make payments for surgeries for aortic valve stenosis or regurgitation combined with aortic root aneurysm, dissection or abscess.

142

N06.01.070

Biological pulmonary valves of all sizes

Item

Make payments for surgeries for replacement of pulmonary valve or trunk due to the following pathological conditions:

- Pulmonary valve stenosis, regurgitation or defect (for example, Fallot’s tetralogy disease);

...

...

...

- Pulmonary valve infective endocarditis;

- Double outlet right ventricle;

- Aortic displacement combined with pulmonic stenosis, etc.

- Other conditions that cause failures to reconstruct valve or pulmonary artery using other materials.

N06.02.000

6.2 Stents

...

...

...

N06.02.010

Coronary artery stents of ordinary types (non-medicated) of all sizes

Item

Payment sum: VND 20,000,000 per each.

144

N06.02.020

Drug-eluting coronary artery stents of all sizes

Item

...

...

...

145

N06.02.030

Renal artery stents of all sizes

Item

Payment sum: VND 20,000,000 per each.

146

N06.02.040

Limb artery stents of all sizes

Item

...

...

...

147

N06.02.050

Carotid artery stents of all sizes

Item

Payment sum: VND 30,000,000 per each.

148

N06.02.060

Thoracic aortic stent grafts of all sizes

Item

...

...

...

149

N06.02.070

Abdominal aortic stent grafts of all sizes

Item

Payment sum: VND 280,000,000 per each.

150

N06.02.080

Intravenous stents of all sizes for channeling blood flow

Item

...

...

...

Payments are made in case of:

- Wide-necked unruptured cerebral aneurysm or a grant aneurysm posing a risk of compression or an aneurysm developing against the direction of blood flow or post embolic recanalization or impossibility of treating an aneurysm by inserting a metal coil;

- An aneurysm already ruptured in the period of stability;

- An aneurysm already ruptured prior to the period of stability but unlikely to be treated by solely using a metal coil.

151

N06.02.090

Covered stent scaffolds of all sizes

Item

Payment sum: VND 70,000,000 per each.

...

...

...

N06.02.100

Stents of all sizes

Item

N06.03.000

6.3 Artificial intraocular lens

...

...

...

N06.03.010

Artificial intraocular lens (IOL, toric IOL) of all sizes (tough, soft and hanging)

Item

Payment sum: VND 3,000,000 per each.

N06.04.000

6.4 Artificial bones, cartilages, joints and tendons

...

...

...

N06.04.010

Artificial rounded bone top kits of all sizes (rounded bone heads and associated parts)

Set

155

N06.04.020

Artificial vertebrae, spinal fusions, intervertebral discs used for spinal surgeries of all sizes

Item, piece, box

...

...

...

N06.04.030

Artificial tendons of all sizes

Segment

157

N06.04.040

Biological ceramic of all sizes used for replacing natural bones

Item

...

...

...

N06.04.050

(Total or partial) artificial joints or joint cavities of all sizes

Set

N06.04.051

Total hip joints of all sizes

Set

Payment sum: VND 45,000,000 per each.

...

...

...

N06.04.052

Partial hip joints of all sizes

Set

Payment sum: VND 35,000,000 per each.

N06.04.053

Knee joints of all sizes

Set

Payment sum: VND 45,000,000 per each.

...

...

...

N06.04.054

Shoulder joints of all sizes

Set

Payment sum: VND 35,000,000 per each.

159

N06.04.060

Artificial cartilages of all sizes

Segment, piece

...

...

...

N06.04.070

Stored bones, biological products of all sizes used for replacing natural bones

Item

161

N06.04.080

Small bones used for surgeries for reconstruction of sound transmission systems

Item

...

...

...

N06.04.090

Artificial bones of all sizes

Segment, piece

N06.05.000

6.5 Patches, grafts or implants

...

...

...

N06.05.010

Biological patches of various types

Pad

164

N06.05.020

Groin hernia, abdominal wall grafts of all sizes

Item

...

...

...

N06.05.030

Cranial implants of all sizes

Pad

166

N06.05.040

Cardiac patches, vascular patches of all sizes

Pad

...

...

...

N06.06.000

 6.6 Other replacement, grafting or implantation materials

167

N06.06.010

Skin grafts of all sizes

Sheet, piece

...

...

...

N06.06.020

Other biological membranes of all sizes for treatment procedures

Sheet, piece

169

N06.06.030

Biological glues used for medical treatment processes

Jar, tube

...

...

...

N06.06.040

Amnions of all sizes

Sheet, piece

171

N06.06.050

Prosthetic tissue regeneration films of all sizes

Unit, piece

...

...

...

N06.06.060

Cultivated keratinocytes, fibroblasts of all sizes for treatment of burns or other injuries

Sheet, piece

173

N06.06.070

Artificial meninges, artificial grafts or patches films of all sizes

Unit, piece

...

...

...

N06.06.080

Incubation, cultivation films and products of all sizes

Unit, piece

N07.00.000

Group 7. Medical supplies used in several departments

...

...

...

N07.01.000

7.1 Medical supplies used in interventional cardiovascular and radiology specialties

175

N07.01.010

Intravascular ultrasound catheter kits of all sizes (including ultrasound probes and conduit sheaths)

Set

...

...

...

N07.01.020

Cannulas of all sizes for transfusion of cardioplegia solutions

Set

177

N07.01.030

Catheterization kits of all sizes for intravenous therapy (including: shunts, guidewires, catheters for guiding optical cables and ablation lines)

Set

...

...

...

N07.01.040

Kits for ligation of atrial septal defects, ventricular septal defects, arterial duct, left atrium and other cardiovascular defects

Set

179

N07.01.050

Stent grafting instrument kits of all sizes

Set

...

...

...

N07.01.060

Instrument kits of all sizes for RF treatment of arrhythmia

Set

181

N07.01.070

Instrument kits of all sizes for transcatheter treatment of atrial fibrillation

Set

...

...

...

N07.01.080

Instrument kits of all sizes for measurement of fractional flow reserve and catheterization

Set

183

N07.01.090

Instrument kits of all sizes for coronary rotablation (including rotawires, lubricant rotaglides, rotalink burrs, rotalink rotablator advancers)

Set

...

...

...

N07.01.100

Instrument kits of all sizes for collecting blood clots (including suction tubes, microcatheters for blood clot removal and rotablation and stents for pulling blood clots out, etc.)

Set

185

N07.01.110

Catheterization instrument kits (including puncture needles, guide wire, introducer sheath)

Set

...

...

...

N07.01.120

Heart valve repair instrument kits of all sizes (including balloons and other accessories)

Set

187

N07.01.130

Embolisation instrument kits of all sizes

Set

...

...

...

N07.01.140

Coil insertion instrument kits of all sizes

Item

189

N07.01.150

Instrument kits for intracardiac electrophysiology exploration (machines, electrodes, etc.) of all sizes

Set

...

...

...

N07.01.160

Instrument kits of all sizes for replacement of heart valve through catheters, repair of heart valve through catheters

Set

191

N07.01.170

Instrument kits of all sizes for cardiac catheterization for hemodynamic exploration and arterial imaging (catheters for imaging of coronary artery, other arteries, heart chambers)

Set

...

...

...

N07.01.180

Instrument kits of all sizes for cardiac catheterization for hemodynamic exploration and heart chamber imaging

Set

193

N07.01.190

Amplatzer parachute-shaped delivery instrument kits of all sizes

Set

...

...

...

N07.01.200

Disposable instrument kits for oesophageal vein ligation

Set

195

N07.01.210

Cardiopulmonary bypass kits of all sizes

Set

...

...

...

N07.01.211

Cardiopulmonary bypass kits for cardiac procedures

(including:

- Artificial lung (including reservoirs, oxygen blenders, heat exchangers);

- Circuit system associated with the steam trap

- Blood filter;

- Cannula connected to blood vessels

- Connector or Y-junction

Set

...

...

...

N07.01.212

Extracorporeal membrane oxygenation kits for intensive care

(including:

- Artificial lung (including oxygen blender, heat exchanger);

- Circuit;

- Components for insertion of cannulas into blood vessels (including artery and vein);

- Closed blood reservoir;

- Compact centrifuge pump;

...

...

...

- Flow sensor.

Set

196

N07.01.220

Pressure pumps of all sizes

Piece, set

197

...

...

...

High pressure pumps of all sizes for imaging of cardiovascular chambers

Set

198

N07.01.240

Balloons, intra-aortic counterpulsation balloon pumps, dissection balloon pumps, blocker balloons of all sizes

Piece, set

199

...

...

...

High pressure pump lines, photoresist high pressure pump lines of all sizes

Item

200

N07.01.260

High pressure guide wires of all sizes for measurement of FFR

Set

201

...

...

...

Guide wires of all sizes

Item

202

N07.01.280

Parachute-shaped amplatzer occluders, self-expanded wire mesh parachute-shaped stents of all sizes

Piece, set

203

...

...

...

Parachute-shaped devices of all sizes for control of embolism downstream in the coronary artery and other arteries for prevention of deep venous thrombosis during interventional procedures

Item

204

N07.01.300

Instruments of all sizes for coronary fixation

Item

205

...

...

...

Instruments of all sizes for inserting or cutting metal coils (coil-pushing wires and coil-cutting wires)

Item

206

N07.01.320

Vein sealing instrument kits of all sizes (angioseal; perclose…)

Set

207

...

...

...

Multi-snare instruments of all sizes for removing foreign bodies

Item

208

N07.01.340

Instruments of all sizes for removal of atherosclerotic plaques

Item

209

...

...

...

CO₂ blowers with water insufflations of all sizes

Item

210

N07.01.360

Apex hanging instruments of all sizes

Item

211

...

...

...

Venous embolization glues (Onyx, Histoacryl..)

Jar, tube

212

N07.01.380

Needles of all sizes for aspiration of gases at the artery root

Item

213

...

...

...

IVC filters of all sizes

Item

214

N07.01.400

Pacemakers of all sizes (including machine units and circuits)

Set

...

...

...

Single-chamber pacemakers

Set

Payment sum: VND 42,000,000 per each.

N07.01.402

Dual-chamber pacemakers

Set

Payment sum: VND 70,000,000 per each.

...

...

...

Triple-chamber pacemakers for cardiac resynchronization during heart failure treatment process

Set

Payment sum: VND 240,000,000 per each.

N07.01.404

Pacemakers with implantable cardioverter defibrillator

Set

Payment sum: VND 260,000,000 per each.

215

...

...

...

Intracoronary, carotid, peripheral vascular shunts of all sizes

Item

216

N07.01.430

Embolisation materials (PVA plastic, lipiodol particles, etc.) of all sizes

Piece, bar, jar

217

...

...

...

Embolization materials of all sizes for liver cancer treatment

Piece, bar, jar

218

N07.01.450

Temporary embolization materials (spongel) of all sizes

Piece, bar, jar

219

...

...

...

Micro guide wires of all sizes

Item

220

N07.01.470

Coils and matrix coils of all sizes

Item

221

...

...

...

Instrument kits of all sizes for RF treatment of arrhythmia using the 3D mapping of cardiac anatomy – electrophysiology

Set

222

N07.01.490

Pulling balloons of all sizes

Piece, set

223

...

...

...

X-ray films of all sizes

Item

Do not qualify for separate payments

N07.02.000

7.2 Blood purification, hemodialysis, peritoneal filtration, peritoneal dialysis

224

...

...

...

Disposable emergency peritoneal dialysis kits of all sizes

Set

225

N07.02.020

Peritoneal filtration, peritoneal dialysis instruments (including dedicated catheters, titanium connectors and circuits)

Set

226

...

...

...

Disposable blood transfusion kits of all sizes

Set

227

N07.02.040

Plasma separators and guidewires of all sizes

Each, set

228

...

...

...

Filters and guide wires of all sizes used in continuous molecular absorption techniques

Set

229

N07.02.060

Blood purification filters, membranes and associated guide wires of all sizes for continuous renal replacement therapies and continuous blood ultrafiltration

Each, set

230

...

...

...

Blood purification filters and membranes, and guide wires of all sizes for periodic hemodialysis (artificial kidney)

Set

231

N07.02.080

Artificial kidneys of all sizes used for hemodialysis

Each

...

...

...

7.3 Opthalmology, otorhinolaryngology and odonto-stomatology

232

N07.03.010

External tooth locks of all sizes designed as threaded rods for dental treatment

Set

233

...

...

...

Disposable scleral scalpels of all sizes for vitrectomy and rectinal surgery

Set

234

N07.03.030

Artificial anterior chambers of all sizes for corneal transplantation

Set

235

...

...

...

Ophthalmic emulsions or solutions for Phaco cataract surgery

Ampoule, tube

236

N07.03.050

Surgical pigments for ophthalmic operations

Ampoule, ml

237

...

...

...

Disposable or reusable tips or instrument kits of all sizes for vitrectomy, anterior segment anatomy, papillary membrane anatomy and lens anatomy

Kit, item

238

N07.03.070

Disposable probes of all sizes for quick tonsil surgeries or nasal coblation

Kit, item

239

...

...

...

Electrical cautery probes of all sizes used for intraocular thermal coagulation during the vitrectomy process

Item

240

N07.03.090

Phaco tips of all sizes

Unit

241

...

...

...

Freezing probes of all sizes for sclera treatment

Unit

242

N07.03.110

Disposable blades of all sizes used for laryngectomy, functional endoscopic sinus surgeries, adenoid removal

Item

243

...

...

...

Cables, guidewires; laser probes, laser illuminators of all sizes for ophthalmic surgeries

Item

244

N07.03.140

Glaucoma sutures of all sizes for scleral surgeries

Unit

245

...

...

...

Intraocular scissors of all sizes

Unit

246

N07.03.160

Disposable clamps of all sizes for peeling off internal limiting membranes (in vitrectomy and rectinal surgeries)

Item

247

...

...

...

Nasal, ear and sinus meroches and sponges of all sizes

Item

248

N07.03.180

Intraocular magnets of all sizes

Set

249

...

...

...

Shunts and express Glaucoma filtration devices of all sizes

Item

250

N07.03.200

Silicone hoses, oils, belts, sheets of all sizes used in opththalmic surgeries

Piece, bottle

251

...

...

...

Disposable or reusable pincers of all sizes used for peeling off membrane during eye surgeries

Unit

252

N07.03.220

Capsular tension rings of all sizes

Item

253

...

...

...

Positively charged emulsions for ocular surface protection

Ampoule, tube

Make payments for medical procedures involving ocular surface interventional surgeries or operations. Do not qualify for separate payments

254

N07.03.240

Nerve monitoring electrodes of all sizes

Item

255

...

...

...

Vacuum assisted closure pads of all sizes

Sheet, piece

256

N07.03.260

Electric voice and larynx prostheses of all sizes

Item

257

...

...

...

Filling materials of all sizes used for eyeball evisceration surgeries

Unit, piece

N07.04.000

7.4 Gastroenterology

258

...

...

...

High-frequency electrical instrument kits of all sizes used for haemorrhoid surgeries (including haemorrhoidectomy HCPT kits, haemostatic clamps, coagulation instruments, high-frequency guidewires)

Set

259

N07.04.020

Instrument kits of all sizes for percutaneous gastric opening (including puncture needles, dilation cannulas and lines with fixing straps)

Set

260

...

...

...

Anal dilator kits of all sizes

Set

261

N07.04.040

Automatic tools or devices of all sizes used for longo technique (including associated rings or staplers)

Set

262

...

...

...

Automatic ablation and suture tools or devices of all sizes used in Doppler technique (including hemorrhoidal artery probes)

Set

263

N07.04.060

Gastrointestinal tract (esophagus, stomach, duodenum, small bowel, rectum and large intestine) polyp snares of all sizes

Item

264

...

...

...

Support sheets, drapes and mesh netting of all sizes for medical treatment and surgery

Pad, sheet

265

N07.04.090

Instruments of all sizes for removing intestinal worms, helminthes or foreign bodies

Kit, item

266

...

...

...

Baskets, balloons of all sizes for extraction of stones, foreign bodies, polyps and clinical specimens

Item

N07.05.000

7.5 Urology

267

...

...

...

Urological cartridges, clips and ablation or suture instruments of all sizes

Item

268

N07.05.020

Nephrostomy intubation kits of all sizes (including puncture needles, dilation catheters, sondes J-J and tubes for draingage of fluids)

Kit, item

269

...

...

...

Peritoneal dialysis kits of all sizes

Set

270

N07.05.040

Plastic dilators associated with amplatzers of all sizes for percutaneous nephrolithotomy

Set

271

...

...

...

Plastic ureter dilators of all sizes

Set

272

N07.05.060

Wire probes of all sizes for ureteral lithotripsy

Item

273

...

...

...

Nephrolithotomic tips or electrodes of all sizes

Item

274

N07.05.080

Cables; laser emitting diodes of all sizes for prostatic hyperplasia treatment

Item

275

...

...

...

Electrodes of all sizes for endoscopic ablation prostatic hyperplasia enucleation and ablation surgeries

Item

276

N07.05.100

Dormia air ventilators for endoscopic ureteral nephrolithotomy

Item

...

...

...

7.6 Traumatology and orthopaedics

277

N07.06.010

Powder bandage coats and splints of all sizes

Item

278

...

...

...

Spinal orthosis vests and orthopedic shoes of all sizes

Unit

279

N07.06.030

Cement dispensing instrument kits of all sizes (including puncture needles, cement, pressure pumps)

Set

280

...

...

...

Nails, splints, clips, needles, screws and braces of all sizes used for orthopaedic surgery

Piece, set

281

N07.06.050

Frames, belts, splints or torsion shafts of all sizes for traumatology and orthopaedics and rehabilitation purposes

Piece, set

282

...

...

...

Load bearing chest plates of all sizes

Item

283

N07.06.070

Chemical cement of all sizes used for verterbroplasty, cranioplasty and arthroplasty

Gram, bottle

284

...

...

...

Surgical water pump lines, electrical ablators, electrical ablation knife handles of all sizes

Item

285

N07.06.090

Orbital bone (orbital floor) reconstruction, cranial reconstruction materials of all sizes

Pad, sheet

...

...

...

7.7 Hematology and blood transfusion

286

N07.07.010

Toolkits of all sizes for separating leukocytes, platelets and plasmas

Set

287

...

...

...

Stem cell separation toolkits of all sizes

Set

288

N07.07.030

Histocompatibility determination toolkits of all sizes

Set

289

...

...

...

Leukocyte films of all sizes

Item

N08.00.000

Group 8. Medical supplies used in other medical diagnoses and therapies

290

...

...

...

Surgical cartridges and sutures of all sizes

Item

291

N08.00.020

Compression bandages of all sizes for venous treatment

Item

292

...

...

...

Autoclave tapes of all sizes

Roll

293

N08.00.040

Pressure transfusion bags of all sizes

Item

294

...

...

...

Surgical camera protective bags of all sizes

Item

295

N08.00.060

Protective bags of all sizes for protection of ultrasonic scanning apparatus

Item

296

...

...

...

Disposable blood pressure measurement bags of all sizes for newborns or adults

Unit

297

N08.00.080

Kits of all sizes for effusing bodily fluids or abscesses (including puncture needles, dilation or draining tubes)

Set

298

...

...

...

Kits of all sizes for intubating chemical infusion catheters (puncture needles, tubes and guidewires)

Set

299

N08.00.100

Disposable or reusable probes of all sizes

Set

300

...

...

...

Intracranial pressure measurement kits of all sizes

Set

301

N08.00.120

Oxygen volume and arterial blood gas test kits of all sizes

Set

302

...

...

...

Thermal tumor ablation kits of all sizes, including thermal ablation needles, connecting wires and adhesive electrodes

Set

303

N08.00.140

Disposable endotracheal tubes of all sizes

Set

304

...

...

...

Chemical infusion chambers of all sizes

Set

305

N08.00.160

Disposable SpO₂ sensors of all sizes

Item

306

...

...

...

Surgical cold-light cables of all sizes

Unit

307

N08.00.180

Surgical photography tips of all sizes

Set

308

...

...

...

Conical probes of all sizes

Item

309

N08.00.200

Probes of all sizes for endoscopic bile duct lithotripsy

Item

310

...

...

...

Venous cautery tips or welding blades of all sizes

Unit

311

N08.00.220

Disposable wash and aspiration catheter tips of all sizes

Item

312

...

...

...

Cables and invasive blood pressure sensors (dome) of all sizes

Set

313

N08.00.240

Tongue depressors (made from wood, stainless steel or metal) of all sizes

Item

314

...

...

...

Adhesive electrode pad, adhesive electrodes, electrode cushions of all sizes

Item, piece, unit

315

N08.00.260

Clips or clamps of all sizes

Item

316

...

...

...

Catheter sheaths

Item

317

N08.00.310

Masks of all sizes

Unit, piece

318

...

...

...

Surgical drill bits (including cutters) of all sizes

Piece, set

319

N08.00.340

Air filtration films of all sizes

Item

320

...

...

...

Antibacterial filtration films of all sizes

Item

321

N08.00.360

Disposable surgical staplers of all sizes

Set

322

...

...

...

Thermal insulation sheets of all sizes

Item

323

N08.00.380

Epidural anesthesia kits of all sizes

Set

324

...

...

...

Transducers of all sizes for radiofrequency ablation

Set

325

N08.00.410

Continuous blood purification dialysates

Bag

326

...

...

...

Preservation media for tissues, glands and corneas; cardioplegic solutions of all types

Ml, litre

327

N08.00.430

Radioactive seed implantation instruments of all sizes

Set

328

...

...

...

Guide instruments for microsurgical treatment of ventricular tumors and PTD instruments for malign brain tumors of all sizes

Set

329

N08.00.450

Brachytherapy instruments (including implant tools, implant needles for cervix, uterus, vagina, rectum, breast, sinuses, soft tissues, skins, nasopharynx, esophagus, trachea, bronchus, lung and lymph node, etc.) of all sizes

Set

330

...

...

...

Resin microspheres filled with Y-90 (including microspheres, lead pots, vials, tubes containing standard doses, cannula, needles and syringes particularly intended for administering radioactive granules)

Set

Make payments at the rate of 40% in case of primary liver cancer or secondary liver cancer which has not metastasized to other body parts or is inoperable.

331

N08.00.470

Disposable plastic trocars of all sizes for endoscopic surgeries

Kit, item

...

...

...

Group 9. Medical replacement parts or supplies used for certain diagnostic and therapeutic equipment

Do not qualify for separate payments

332

N09.00.010

Infrared lamps of all sizes

Unit

333

...

...

...

Ultraviolet lamps of all sizes

Unit

334

N09.00.030

Beam emitters of radiotherapy accelerators of all sizes

Item

335

...

...

...

SPECT pen point markers of all sizes

Item

336

N09.00.050

Phantoms of all sizes

Set

337

...

...

...

Body fixation sheets of all sizes for accelerated radiotherapy

Item